Inflammatory Bowel Disease in Dogs

What to do when the dogs immune system overreacts to the intestines own good bacteria.


“Jessie was one of a kind,” says Bill Tidman of his shepherd/collie mix. “Other than my wife, she was my best friend.”

“She was just such a special dog,” says Mr. Tidman’s wife, Sharon. “I called her my soul dog. She was my baby girl. When she first came here, [the Tidmans acquired her from the dog officer when she was a puppy] she was so excited to be with us she bounced from couch to couch. It was just so cute.

“She had always been a little sensitive,” Mrs. Tidman continues — “some diarrhea. But it never stuck. She’d have it, and it’d go away.”

“Always soft stools,” Mr. Tidman chimes in. “Even as a puppy, she never had a firm bowel movement.”

But when Jessie was about nine years old, something changed in the household. The Tidmans’ other dog, a springer spaniel named Missy, was diagnosed with cancer. And she kept having accidents in the house— or so the Tidmans thought.

But two weeks after Missy died, “all of a sudden Jessie’s diarrhea had gotten to the point where it had never gone before. We started to put two and two together — it hasn’t been Missy but Jessie. It wouldn’t stop. She was messing in the house. At first we thought it might be because she was missing Missy.

“We took her to the vet, and he told us to get Jessie to Tufts.”

When she arrived, an emergency crew immediately took over. Jessie was in dire straits — dangerously dehydrated and weak from all the water and electrolyte loss in the diarrhea. She was put on an IV for three days.

“An internist took over,” says Mrs. Tidman, “and he gave us three scenarios as to what the problem might be: colon cancer, something else that she would not survive — another cancer, I think it was, and IBD, or inflammatory bowel disease.”

Enter Dr. Stone
The Tufts internist assigned to Jessie’s case was Michael Stone, DVM, DACVIM. He diagnosed IBD, but confirmation of the disease didn’t come right off the bat.

“The most difficult part of dealing with IBD is an accurate diagnosis,” Dr. Stone says, “because stomach upset is non-specific. It can be any number of things. And there’s no test that pinpoints IBD specifically. You must exclude other things. Diagnosis can only be made after ruling out various conditions.

“For instance,” he explains, “IBD can mimic the presence of parasites such as worms in the gastrointestinal tract, or cancers of various organs,” including the colon.

IBD can also look like an overgrowth of bacteria in the gut. “It’s a little bit complex and controversial,” Dr. Stone says, “but some dogs on low-fiber diets will experience bacterial overgrowth and, as a result, have recurring diarrhea. That’s not IBD, even though the problem commonly gets misdiagnosed as such. It tends to happen with dog foods promoted as resulting in low-residue stools, meaning owners have to clean up less in the yard. But dogs with the problem have to go on a higher-fiber diet, which their veterinarians can help their owners choose.” That situation is actually much more common than IBD.

Jessie wasn’t on a low-fiber diet, though. She didn’t have a food intolerance, either, which is sometimes responsible for diarrhea. Thus, finally, after checking for a number of other diseases, Dr. Stone diagnosed IBD.

Jessie had probably had it her entire life, he told the Tidmans, which is why her stools were never quite right. It was most likely hereditary, although often it comes from out of the blue rather than giving signs from the beginning. It just reached a crescendo at a certain point.

The illness comes not from an overgrowth of bacteria but from an overreaction of the dog’s immune system to the good bacteria in her intestine. That causes intestinal inflammation, hence, the word “inflammatory” in the name of the disease.

Mild, moderate, severe
Jessie had the most severe form of IBD, experiencing not only dehydration but also significant weight loss. “She lost maybe 10 to 15 pounds up front,” Mrs. Tidman says.

Her blood work became abnormal, too, because with the severest form of the disease, blood proteins drop — they literally leak into the intestines. And she went through electrolyte imbalance, with a deficiency of potassium.

“Some cases have only mild signs,” Dr. Stone says, “lip smacking or pica — eating abnormal things, such as grass, or licking the floors, anything unusual.”

The moderate version of the disease — in between mild and severe — “is the most common form that I see,” he comments. “That would be dogs with intermittent vomiting, diarrhea, and/or loss of appetite. And upset stomach. Typically, the hallmark is that it’s cyclic. One bad week, two good weeks, one bad week, etc.”

Treatment protocol
“What we have to do is tone down the immune system,” Dr. Stone says. Often that means starting with a course of prednisone, a steroid, which reduces inflammation, perhaps for up to six months. But most dogs need to be treated for life. “It tends not to go away,” Dr. Stone says.

And prednisone on a long-term basis can be more dangerous to a dog’s health than the disease itself. It’s for that reason that referral to a veterinary internist is encouraged; he can prescribe a course of drugs on a long-term basis and adjust dosages and prescriptions as the need arises.

Jessie, after being weaned off a long course of prednisone, was at various times on up to five drugs a day, “some pills twice a day,” says Mr. Tidman, who kept her dosing schedule on the computer. At one point, she came down with pancreatitis — inflammation of the pancreas — in the middle of her treatment, which only made her digestive system that much more vulnerable.

The doctor was able to help the Tidmans get the pancreatitis under control (with a reduced-fat diet) and she went on to live a reasonably good quality of life for two and a half years. “We had Jessie pretty stabilized,” Mr. Tidman says, “with some tweaking of the medicines. She had periodic diarrhea all through,” but no dire emergencies.

Some of the drugs prescribed for toning down the immune system include cyclosporine, azathioprine, and mycophenolate. Jessie was also given potassium pills to combat electrolyte loss from the dehydration she experienced at times. “She drank a lot of water,” Mr. Tidman says. “We used to have a gallon dog dish. She would drink that within half a day.”

Jessie’s outcome
“Jessie was diagnosed with IBD in 2013, about a month after the Boston Marathon bombing,” says Mrs. Tidman. But in December of 2015, she became listless and uncomfortable. “We were taking turns sleeping downstairs with her,” Mr. Tidman says. “She couldn’t come upstairs anymore. She was very weak.”

Dr. Stone found nodules on her intestine — perhaps cancer — and between that, her ongoing issues with IBD (which was getting harder to control) and the fact that she was so unhappy, he told the Tidmans that he would support their considering the idea of putting her down.

They didn’t have to. On the morning of the day they were going to bring her in for euthanasia, she had “an extreme purge,” as Mrs. Tidman puts it, and then passed away on the sun porch.

The couple wasn’t completely surprised by the outcome. “We were told that she would live out her life with whatever control we could obtain from the drugs but that ultimately the disease was going to take her. This disease was hell-bent on taking Jessie,” Mr. Tidman adds.

The Tidmans still miss their “baby girl” but wouldn’t have given up a single day taking care of her. n

Note: Dr. Stone says that in 80 percent of cases, which are moderate rather than severe like Jessie had, dogs go on to live normal lives, and normal life spans, once IBD is brought under control.


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